“Childbirth is the number one killer of teenagers,” the Metro today warned, while The Daily Telegraph reported that “one million teenage girls 'suffer death or injury from pregnancy'”.

These alarming headlines stem from a new charity report looking at improving family planning in the developing world. The report, from the charity Save the Children, highlights the fact that girls under the age of 15 are five times more likely to die in pregnancy than women in their 20s, and that babies born to younger mothers are also at greater risk. It’s important to note that this is a global figure, which includes the high number of teenage pregnancies in the developing world. It should not cause unnecessary alarm to teenage mothers in the UK.

Save the Children’s report calls for more funding to make contraceptives more easily available, and for laws and education to enable women to decide whether and when to have children.

What is the background to this?

The charity Save the Children operates in 120 countries and aims to save children’s lives, defend their rights and help them to fulfil their potential. The new report “Every Woman’s Right: How family planning saves children’s lives,” highlights that family planning is a fundamental right that is vital to both children’s chances of survival and to the lives of adolescent girls and women.

The report insists that family planning is not simply about controlling population, and identifies that it could help to save children’s lives by:

*Ensuring safer gaps between pregnancies. *The report says that having a baby too soon after a previous birth is dangerous for both mother and baby. Giving women access to family-planning services can allow an interval of at least three years between births, which the charity says could help save the lives of nearly 2 million children each year.

Preventing children from having children. Worldwide, complications in pregnancy are the “number one killer” of girls and young women aged 15-19, the report says, adding that 50,000 teenage girls and young women die during pregnancy and childbirth every year, in many cases because their bodies are not ready to bear children. Babies born to young mothers are also at greater risk: each year about 1 million babies born to adolescent girls die before their first birthday. In developing countries, if a mother is under 18, her baby’s chance of dying during the first year of life is 60% higher than a baby born to a mother older than 19. Many adolescent girls know little about family planning, let alone where to get it. Girls’ low status within families and communities means they lack the power to make their own decisions about whether or when to have a baby.

However, the charity says there has been progress in the last two decades. For example, the number of mothers who die during childbirth is lower. Family-planning services are key to this progress, according to the report. Yet while the proportion of couples who use “modern” contraception (such as the Pill) increased from 41% in 1980 to 56% in 2009, over the last decade progress has slowed drastically. At least 220 million women worldwide do not have the option of deciding to delay their first pregnancy, allow a longer space between pregnancies or limit the size of their families.

Two-fifths of births in the developing world are unintended, with millions of women unable to access family-planning services, says Save the Children. The biggest unmet need is in countries with large populations in south Asia and Africa.

What are the reasons for lack of access to family planning?

In some countries, family planning is often not available because of limited supplies of contraceptives. The report says: “If a woman has gone to a great deal of trouble to get to a clinic, only to find that contraceptive supplies have run out or her method of choice is out of stock, or if she is directed to a private provider that she cannot afford, she may well choose not to return.” Sometimes contraceptives go unused because there are no healthcare facilities or workers to distribute them, the report says.

Many women and girls are unable to exercise their rights to make decisions over their own healthcare, including when to get pregnant, the report says. Some women are unable to use family planning because of social and cultural attitudes, the authors suggest. Some may be unwilling to use it because of ill-informed fears about side effects and myths about contraception.

Why is birth spacing important?

The report says that having children too close together is dangerous for both mother and child, because:

Pregnancy and breastfeeding can deplete the stores of vitamins and minerals in the mother’s body, with the result that babies conceived fewer than six months after a prior birth are 42% more likely to be born with a low birth weight. Waiting longer to conceive after a birth means a new baby is given the best start in life.

Siblings born within a relatively short space of time are affected throughout infancy and childhood. They are more likely to be malnourished and at greater risk of dying from illnesses such as pneumonia and diarrhoea.

Short spaces between births are dangerous for mothers. Women who become pregnant again fewer than five months after a birth are more than twice as likely to die from a pregnancy-related cause than women who wait for 18 to 23 months between births.

Adolescent pregnancy carries high risks for both girls and their babies. Globally, about 50,000 teenage girls die each year in pregnancy and childbirth, while one million babies born to adolescent girls die before their first birthday.

However, it should again be noted that these statistics are much more likely to apply to pregnant teenagers and their babies in the developing world than in the UK.

The report says mothers should leave a gap of at least three years between each birth, to reduce the risk to themselves, their existing children and their unborn babies. If mothers were able to delay conceiving again for 24 months after giving birth, 13% of deaths among children under the age of five would be averted, the report says.

Why are adolescent girls at risk?

The report says that around 16 million girls between the ages of 15 and 19 give birth every year, as do many younger girls. In many countries, girls have a 10% chance of becoming a mother before they reach the age of 15, it says. It does not specify how many girls in the UK become pregnant before the age of 15, but the latest UK statistics for 2010 say that there are seven pregnancies per 1,000 girls aged under 16 (0.7%).

Girls under 18 are reportedly more likely to give birth to premature babies and have complications during labour. Their bodies are not physically ready for childbirth and their pelvises are smaller, so they are more prone to suffer obstructed labour. This can put women at greater risk, especially in the absence of emergency obstetric care as may be the case in some countries.

The report says that in many societies adolescent girls have low status and do not have the opportunity to make decisions about reproduction. Sexual abuse, parental absence and poverty are all factors in a high rate of adolescent pregnancy. Evidence suggests that up to 23% of married women between 15 and 24 in developing countries were forced to have sex by their spouse. Many girls are given little information about sex and contraception.

The report says that early pregnancy is intrinsically linked to the practice of child marriage, which happens to an estimated 10 million girls under 18 every year. One study found that 46% of 15-19 year old girls who were married had never used any contraception. It is reported that this is linked to a number of factors including social pressure to have children, inability to discuss family planning, fear of the (often older) husband and lack of mobility.

How can family planning be improved?

The report estimates that 222 million women worldwide have an unmet need for family planning. It says if this was addressed, 79,000 women and 570,000 babies could be saved. While the report does not specify the timescale for this, it appears to be based on an annual projection for 2012.

In the report, Save the Children sets out the following five recommendations that the charity wants national leaders to address.

Fill the funding gap

The charity wants national governments, private companies and international donors to “fill the funding gap” for family planning in developing countries, estimated at US$4.1 billion a year.

Put health workers at the heart of family-planning services

Training, pay and support for enough healthcare workers is key, says the report. Family-planning services rely on trained health workers to provide counselling and information about contraception, as well as handing out condoms or injecting contraceptive implants.

Equity

Currently, many areas with the greatest need have inadequate health facilities and poor infrastructure, and these problems are exacerbated by conflict or natural disasters. The report calls for strategies to address this and ensure that contraception is accessible and affordable for the poorest and most vulnerable women.

Invest in education

Schooling should be improved and girls should stay in school for longer, says the report, because of the link between better education and greater involvement in decision-making. Both girls and boys should be educated fully on sexual and reproductive health and rights, the report says.

Introduce positive policies to protect women

Save the Children wants countries to have laws and policies to guarantee women’s rights, secure female equality and cater for their reproductive health needs.

What happens next?

Save the Children is hosting a summit in London, that it says is a “once-in-a-generation opportunity” to help girls and women make decisions over whether and when to have babies. The charity hopes to persuade world leaders to take appropriate action.